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血浆争论: 有偿捐献血浆的伦理

The plasma debate: The ethics of paying for human blood | Peter Jaworski | Big Think

血浆:为人类血液付费是否正确?
PETER JAWORKSI: Let me tell you about the biggest industry you’ve probably never heard of.
我来告诉你一个你可能从未听说过的大型产业
I’m talking about the blood plasma industry.
血浆产业
The therapies made from plasma help
血浆疗法可以帮助那些患有
people who suffer from primary and secondary immune deficiencies.
原发性和继发性免疫缺陷的人
If you ever have a serious burn you’ll probably need albumin.
如果你有过严重烧伤 你可能需要白蛋白
Albumin is also used to help with a variety of cancers.
白蛋白也可以用来帮助治疗各种癌症
And then there are people whose blood doesn’t clot properly,
还有一些人血凝不正常
people with Von Willebrand disease or people who have hemophilia.
有的人患有血管性血友病 或者血友病
That’s what the plasma therapies are used for.
这就是血浆疗法的用途
And demand for especially immune globulin.
对免疫球蛋白的需求尤其大
The demand for immune globulin is outstripping supply in almost every country.
几乎每个国家的免疫球蛋白都求大于供
血浆:美国的出口量比钢铁还多
Did you know that the United States supplies more than 70 percent
你知道全球超过70%
of all of the plasma in the entire world that is used to manufacture plasma therapies?
用于进行血浆疗法的血浆都来自美国吗?
The whole world is dependent and reliant on the United States of America,
整个世界都稀缺并依赖于美利坚合众国
on people in the United States who give their plasma twice a week on a regular basis.
依赖于美国人每周定期提供的两次血浆
Exports of plasma from the United States
根据《经济学人》的数据
account for 1.6 percent of total exports by GDP according to The Economist.
美国的血浆出口占GDP总出口的1.6%
The New York Times said it was 1.9 percent.
《纽约时报》称这一比例为1.9%
That’s not correct.
并不准确
That number by the way, 1.6 percent of total exports.
顺便一提 这数字占出口总额的1.6%
That’s more than aluminum.
比铝还多
It’s more than steel.
比钢铁还多
It’s the biggest industry you’ve never heard of.
这是你从未听说过的最大产业
It’s about $26 billion I think annual industry.
我认为每年的工业产值大约260亿美元
That’s going to double very soon.
很快就会翻倍
People are anticipating it
人们预计到2040年
to be more than a $40 billion industry by 2040.
这个行业的产值将超过400亿美元
So we’re anticipating incredible growth, ten percent per year.
所以我们预计年增长量会达到惊人的10%
That growth is stable.
增长保持稳定
It’s stable growth.
稳定增长
There are still countries that do not realize
仍然有一些国家没有意识到
that these plasma therapies are effective.
这些血浆疗法的有效性
They simply don’t have the resources or the means to properly diagnose people
他们既没有资源又没有技术来确诊病人
or to give them access to these plasma therapies.
或采用血浆疗法进行治疗
But once they come online that’s going to increase demand as well.
而一旦这些跟上来 需求也会增加
哪些国家允许付费血浆?
Out of all the countries in the world
在世界上所有的国家中
only the ones that pay people to make that donation
只有那些允许有偿捐献血浆的国家
are self-sufficient in plasma therapies.
在血浆疗法方面实现了自给自足
And even the ones that
事实上
pay not all of them are, in fact, sufficient.
并不是所有付费的国家都实现了自给自足
So there are only seven countries in the world
因此 世界上只有7个国家
that legally permit paying people for plasma donations
允许人们合法的有偿捐献血浆
– Germany, Austria, Hungary,
德国 奥地利 匈牙利
Czechia or the Czech Republic, parts of Canada.
捷克或捷克共和国 和加拿大的部分地区
And I’ll talk about Canada in a second.
我马上会讲到加拿大
The United States, of course, and China.
美国 当然还有中国
Those are the seven countries in the world that permit payment.
这是世界上七个允许有偿捐献血浆的国家
Every other country that does not allow payment for plasma donations
所有其他不允许有偿献血的国家
imports plasma therapies that make use of plasma primarily from Americans.
其进行血浆疗法的血浆大都进口自美国
Germans as well, but primarily Americans.
也从德国进口 但主要是美国
That’s an astonishing figure.
这个数字很惊人
This industry is growing so fast.
这个行业发展迅速
In the United States alone the number of plasma centers has more than doubled.
仅在美国 血浆中心的数量就增加了一倍多
In fact, it’s more than tripled since 2004.
事实上 这个数字是2004年的三倍多
There are currently over 824 plasma centers in the United States of America.
目前在美国有超过824个血浆中心
So here’s a question.
所以就有个问题
We know that paying people for plasma works.
我们知道有偿献血的方法行得通
We know that it’s effective precisely because of what I just said.
它之所以行得通原因我之前讲过了
All of these countries depend on paid plasma to make the therapies
所有这些国家都依赖于有偿血浆来进行治疗
and only the countries that pay have enough of them.
而且只有允许有偿献血的国家才有足够的血浆
They produce actually more than enough.
他们实际上生产过量
They have more than enough.
还有富余
They’re able to export to other countries and thank goodness.
他们能够出口到其他国家 谢天谢地
Imagine what the world would be like
想象一下 如果美国不出钱买血浆
if the United States didn’t pay for plasma.
世界会变成什么样子
We wouldn’t have enough plasma therapies.
我们就无法进行那么多的血浆疗法
And at the moment these plasma therapies are used for rare blood disorders
目前 血浆疗法常用于治疗罕见的血液疾病
and for rare diseases.
和其他罕见疾病
Very few people are affected by it.
收益的人很少
Of course that still accounts –
当然 这仍然是个问题
there’s still thousands of people around the world
即世界上仍然有成千上万的人
who use these medicines on a regular basis.
定期使用这些药物
But imagine what would happen
但是想象一下 如果事实证明
if it turns out that plasma is useful for something like Alzheimer’s,
血浆对阿尔茨海默氏症和心脏病等疾病有用
is useful for something like heart disease.
会发生什么
If it turns out that it is useful
如果事实证明
against an ailment, a disease, a problem that very many people are affected by
它对治疗常见小病或顽疾很有用
then demand for these therapies is going to go through the roof.
那么对这些疗法的需求就会飙升
We need to be prepared for that and we need to do what works.
我们需要为此做好准备 做有效的事情
And what works is paying people for plasma donations.
有效之法则是有偿捐献血浆
反对有偿献血的五大依据
So let me talk about Canada for a second
让我花点时间谈谈加拿大
because this is where I’ve done the most work on this issue.
因为我对加拿大这方面的工作做的最多
So at the moment British Columbia,
因此 目前不列颠哥伦比亚省
Alberta, Ontario and Quebec
阿尔伯塔省 安大略省和魁北克省
– this is where more than 80 percent of Canada’s population lives.
加拿大超过八成的人口都居住在这些省份
It is illegal for a commercial enterprise to come in and pay people for plasma donation.
商企从事血浆捐赠或购买血浆是违法的
Meanwhile, Canada continues to import
与此同时 加拿大一直在进口
therapies made with American paid plasma all along.
美国的有偿血浆进行治疗
And those numbers are increasing.
且这个数字还在增加
So why did they ban paid plasma?
那他们为什么要禁止有偿献血呢?
What kinds of arguments did people make
安大略省 阿尔伯塔省和不列颠哥伦比亚省的人
in Ontario, in Alberta and British Columbia?
提出什么样的论点?
I tried to remember all of those arguments
我试着记住所有这些论点
and I’ve got like a little acronym which I call SSACE.
用了一个缩略词SSACE
It’s Safety, Security, Altruism, Commodification and Exploitation.
表示安全 保障 利他主义 商品化和剥削
安全
The first one, safety, is a nonstarter.
首先 安全 不是第一位
Don’t forget that Canada imports therapies made with paid plasma.
别忘了加拿大进口的疗法用的是有偿血浆
So the question of whether or not it’s safe to pay people for plasma donation
因此 有偿捐献血浆的人是否安全这个问题
is not a realistic question.
并不是一个现实的问题
The law doesn’t ban paid plasma
法律没有禁止有偿血浆
and it doesn’t say that it’s going to stop importing paid plasma.
也没有说要停止进口有偿血浆
And by the way, every medical expert body around the world
顺便说一下 世界上每个医学专家机构都说
says that medicine made with paid plasma
用有偿血浆制成的药物
is just as safe as medicine made with unpaid plasma.
和用无偿血浆制成的药物一样安全
The say it’s just as safe.
他们说一样安全
Not a little bit less safe.
完完全全一样安全
They say it’s just as safe.
就是都很安全
The safety issue is simply a nonstarter.
安全问题根本无从说起
It’s not a real issue.
这不算个问题
保障
The security issue is interesting.
保障问题很有趣
It’s an empirical question and that question is
这是一个经验性问题 即
if we allow paid plasma
如果我们允许有偿捐献血浆
will we get enough unpaid blood.
我们会得到足够的无偿血浆吗?
These are two different kinds of donations.
这是两种不同的捐赠
Plasma is the yellow liquid inside of our veins.
血浆是我们静脉内的黄色液体
It’s about 55 percent of the liquid in our veins.
大约占人体血管中血液的55%
When you donate plasma usually you do it through plasmapheresis.
捐献血浆通常是利用血浆置换法
There’s a big machine, takes all of your blood.
用一台大机器 取走你所有的血
It separates the plasma from your red and white blood cells and your platelets
把血浆从你的红白血细胞和血小板中分离出来
and then it returns the red and white blood cells and the platelets back to you
然后把红白血细胞和血小板还给你
and keeps just the plasma.
只保留血浆
A whole blood donation meanwhile takes less time.
而且全血捐献用时更短
It takes about 30 minutes
只需30分钟
as compared to one-and-a-half to two hours. That’s how long plasmapheresis takes.
而置换血浆需要一个半到两个小时
It takes less time but it takes all of those things.
花费的时间较少 但设备需齐全
What that means is that
意思就是
if you donate plasma you can do it twice a week safely.
如果你捐血浆 你可以一周做两次 完全安全
But if you donate blood you can only do that once every 56 days.
但若是献血 你必须间隔56天
Now we don’t pay for blood and the concern
现在我们不进行有偿捐献血浆
is that if we allow both paid plasma
就会遇到这样的问题
and unpaid blood to operate side-by-side
如果允许有偿献血和无偿献血同时存在
then people are going to choose the option that you get paid for
人们就会选择有偿献血
rather than the option that you don’t get paid for.
而不是无偿献血
I think that’s a very serious worry.
我认为这是个非常严重的问题
It is an empirical question.
这是一个经验问题
A colleague of mine and myself we have a paper forthcoming that appears to show
我和一位同事即将发表的一篇论文表明
that there is no effect on unpaid blood donations from the presence of paid plasma centers,
有偿献血中心的存在对无偿献血没有影响
but you’ll have to look up that paper.
但你对这篇论文必须查阅一番
A Health Canada expert panel said the same thing.
加拿大健康专家小组也表达了同样的观点
In the United States, for example, blood donations operate
例如 在美国 献血与有偿血浆手术
side-by-side with paid plasma operations and it’s not that big a deal.
并行进行 已经不算稀奇
Same with in the Czech Republic.
捷克共和国也是如此
The same is true in Austria as well.
奥地利也是如此
So the security issue is another issue that was raised.
所以保障问题是人们提出的又一问题
I think it’s the most important argument that the other side on this debate have raised.
我认为这是这场辩论中对方提出最重要的论点
My own view on it is that it is insufficient on its own
我个人的看法是 仅凭这一点
to justify banning paying people for plasma donations.
还不足以证明禁止人们有偿捐献血浆是正当的
The other three are moral objections and I’ll try to deal with them quickly.
另外三个是道德上的质疑 我马上道来
利他主义
The first one, altruism.
首先是利他主义
The argument is that people should give plasma out of the kindness of their hearts
此论点指的是 人们应该出于好心捐献血浆
and not because what they care about is the thickness of their wallet.
而不是出于对钱包厚度的关心
And so we object to paid plasma
所以我们反对有偿血浆
because we think that like people are doing it with the wrong motives.
因为我们认为人们的动机是错误的
So the first thing to say is that if you’re comparing
所以首先要说的是
getting enough medicine that will save lives
如果你把足够用以拯救生命的药物
to the motives of the people that provide the plasma
和捐献血浆之人的动机相比
it seems like the saving lives is much more important.
似乎拯救生命更重要
So even if people aren’t giving it out of the kindness of their hearts
所以即使人们不是出于他们的善良之心
that doesn’t matter as much as saving as many lives as we possibly can.
那也没有我们尽可能拯救更多的生命重要
That’s the first thing to say.
这是第一个要说的
The second thing to say is that I think it,
第二点要说的是 我认为
in fact, is a kind of prejudice.
这实际上是一种偏见
It’s a kind of stigma that we associate with people who sell their plasma.
一种让我们联想到那些卖血浆之人的耻辱
Because consider none of us, I’m a professor.
因为考虑到我们没有谁 我是一个教授
Guess what?
你猜怎么着?
I get paid to be a professor.
我当教授是有钱拿的
But do I, am I a professor because that’s the way that I maximize my income?
但我是因为做教授最赚钱才当的教授吗?
No, I take seriously my obligation
不 我认真履行我的义务
to let people know about things that are important,
教导人们重要的知识
to try to bring up the next generation.
努力培养下一代
And the same is true of teachers all around the world.
世界各地的教师也是如此
And we do see that teachers can both be paid
我们确实看到 教师既可以得到报酬
and operate altruistically simultaneously.
同时又可以无私地工作
Human motivations are very complex.
人类的动机非常复杂
We think the same thing of nurses.
我们对护士的看法也是如此
We think nurses get paid to be nurses.
我们认为护士是要拿工资的
Same with doctors.
医生也一样
They get paid to be doctors.
他们成为医生是有报酬的
And yet we think that it’s compatible with that for them to operate altruistically.
但我们认为这与利他行为并不相互违背
In a way it’s puzzling in the plasma debate in particular because everybody
在血浆辩论中 尤其令人费解是
who has anything to do with plasma gets paid.
任何与等血浆有关的人都会得到报酬
That includes the phlebotomists, the nurses, the administrators.
包括抽血医生 护士 管理人员
Everybody gets paid except for the person whose plasma it is.
每个人都有报酬 除了捐献血浆的人
And we worry about altruism just when it comes to the person whose plasma it is.
我们担心利他主义只会影响到捐献血浆的人
Why aren’t we concerned about the altruistic motives of nurses, for example, or doctors.
为什么我们不关心护士或医生的利他动机呢
So that’s why I say that argument kind of reveals a sort of prejudice.
所以我才说这个论点揭示了某种偏见
It’s not a very good one.
这种偏见并不好
商品化
The commodification worry goes something like this.
对商品化的担忧是这样的
If we put a price tag on a part of a human being
如果我们给人体的某个部位贴上价格标签
then it’s possible that people are going to start
那么人们可能会开始认为
thinking of themselves as having all of these different price tags.
自己身上有各种不同的价格标签
So they don’t think of themselves as being a person,
所以他们就会忘记自己是个人
as a whole person.
是一个完整的人
They don’t think of themselves as being sacred in a way.
他们某种程度上并不十分看重自己
Instead they start thinking of themselves
而是开始把自己当做
as having different price tags
各种价格标签的集合体
and they’re like well what am I worth.
他们会想我值多少钱
Well actually my blood is worth this much, my plasma is worth this much and
其实我的血液值这么多 血浆值这么多
my hair is worth this much, et cetera.
头发值这么多 等等
The worry is that if we allow
让人担心的是 如果我们给
a price tag on a part of us
自己的身体零件贴上价格标签
then soon we’re going to think of people as commodities
那么很快我们就会把人当作商品
rather than as persons.
而不是人
And my response to that kind of argument is first,
我应对这种论点是 第一
that’s an empirical claim
这是一个经验之谈
and I haven’t seen any studies that show that,
我还没有见过任何研究证明
for example, in the United States people are more likely
例如证明与禁止有偿捐献血浆的
to think of themselves as commodities
安大略省和英属哥伦比亚相比
as compared to in Ontario or British Columbia where it’s not legal to pay people for plasma.
在美国 人们更有可能认为自己是商品
I find that argument a little bit dubious
我觉得这个论点有点存疑
barring empirical evidence.
除非有经验性实例
And secondly, I don’t know why anybody thinks that at all.
其次 我不知道为什么会有人这么想
I mean we pay for labor.
我的意思是我们付了人工费
Why doesn’t that have the effect of commodifying persons.
为什么没有商品化的效果呢
Why is it that if we pay for plasma
如果我们让血浆有偿
then commodification will occur,
那么商品化为什么就一定会发生?
but not in all of the other standard ways.
还不是以其他商品一样的标准化方式发生
Things that we constantly pay for
我们一直在花钱买的东西
and yet do not result in commodification.
却没有实现商品化
剥削
And then the last one which I think is the most important
这最后一个是我认为
moral argument against paying people for plasma.
反对有偿捐献最重要的伦理观点
It’s exploitation.
剥削
If you pay attention to the news in the United States and all over the world,
如果你关注美国和世界各地的新闻
if people are writing about paid plasma
如果人们写关于有偿血浆的文章
they often raise the specter of wrongful exploitation.
他们经常会提到非法剥削
Because here is a fact.
因为这就是事实
Guess who sells their plasma?
猜猜谁在卖他们的血浆?
It’s not professionals.
不是专业人士
It’s not professors like myself.
不是像我这样的教授
It’s students and it’s people who are poor.
是学生和穷人
Poor people
穷人
– the plasma centers are located in zip codes that have higher poverty rates
血浆中心位于贫困率较高
and lower median and household income rates.
中低等家庭收入的地区
So it is the poor that sell their plasma.
所以是穷人在卖他们的血浆
And so that raises the question of whether
这就提出了一个问题
these people are exploited or not.
这些人是否受到了剥削
I don’t think that they are.
我并不认为他们受到了剥削
I think, in fact, that the amount of money that people are paid to sell their plasma
实际上 我认为人们卖血浆的钱
is, in fact, a good deal.
是一笔不错的交易
The global price of plasma is about $200 per liter.
血浆的国际价格约为每升200美元
So the unit is a liter.
单位是升
It’s about $200 per liter
每公升大约200美元
and donors or people who are paid for plasma
捐赠者或购买血浆的人
receive about $50 for that one liter.
每公升大约可以得到50美元
Typically people donate about 810 to 880 milliliters
通常人们会捐出810到880毫升的血浆
and so it takes about one-and-a-quarter donation to make a full liter of plasma.
因此捐一升血浆需要一小时15分钟
So people get paid $50 and $200 is the total price.
献血者得到50美元 总价200美元
That’s a really remarkable, that’s a good deal.
这真的很了不起 很划算
That’s not an exploitative deal.
这不是一笔剥削性的交易
The division of the benefits is fair in my judgment.
在我看来 利益的分配是公平的
Second, there’s still an open question like
第二 还有一个悬而未决的问题
what good do we do –
比如我们做了什么好事
what has Ontario done?
安大略省做了什么?
Ontario has said we’re not going to pay people for plasma.
安大略已表示不会用钱补偿捐献血浆的人
That didn’t result in $50 in the pockets of people who need the money.
这并没有给那些需要钱的人带来50美元
When they banned paid plasma
当他们禁止有偿血浆时
they didn’t replace that
他们并没有用一棵
with a tree where you just grab money from that tree.
你伸手就能够到钱的树来代替
No, they simply removed an option.
不 他们只是取消了一个选项
How did that improve the lives of the people who need the money
这如何改善了那些需要钱的人的生活呢?
and are selling plasma maybe primarily for the money.
那些卖血浆的人可能主要是为了钱
Although footnote, don’t forget I do think that
即使 注意 别忘了 我真的觉得
most of the people that sell their plasma do it
大多数卖血浆的人这样做
both for the money as well as out of concern for their fellow neighbors.
不仅是为了钱 也有出于对邻居的关心
So you don’t really make people better off
所以你并不能通过取消这些选择
by removing those options.
让人们生活得更好
Now if it as something that was very risky then that would be a different matter.
如果是非常危险的事情那就另当别论了
We’re not talking about paying people for kidneys.
我们说的不是让人卖肾
We’re talking about paying people for plasma which is renewable.
我们说的是卖可再生的血浆
It’s renewable and donating it is safe.
它是可再生的 捐赠是安全的
It’s not entirely safe.
并不完全安全
It’s not 100 percent safe, but it is not risky.
它不是百分之百安全 但也没有风险
We are encouraging people to donate plasma.
我们鼓励人们献血
So that’s my response to the exploitation argument.
这就是我对剥削论的回应
That’s my response to all of the arguments against it.
这就是我对所有反对有偿献血观点的回应
And none of those arguments overcome the fact
这些争论都无法克服这样一个事实
that we can get high quality plasma
那就是我们可以用高质量的血浆
for plasma therapies.
来进行血浆治疗
We can get more of it.
我们可以得到更多
And countries like Canada where I’m from, we’re a wealthy country.
像我的祖国加拿大这样富裕的国家
We shouldn’t just be drawing on the global supply of plasma.
我们不应该仅仅依靠全球的血浆供应
We should be contributing to it.
我们应该为此做出贡献
We are not contributing to the global supply of plasma.
我们没有为全球的血浆供应做出贡献
We are taking from it.
而是在不断索取
It’s just as safe as unpaid plasma.
有偿血浆和无偿血浆一样安全
There’s evidence, there’s substantial proof
大量的事例和证据
that paying people for plasma will work.
证明进行有偿捐献血浆是行得通的
The demand for these medicines is growing significantly
对这些药物的需求正在显著增长
and we are simply not equipped to do
除非我们付费给捐助者
what we need to do unless we pay donors.
否则我们根本没有能力做我们要做的事情
It should be legal to pay people for plasma.
法律应该同意有偿献血

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视频概述

有偿或无偿捐献血浆一直都是国际的争论点。看教授如何一一驳回反对者的五大论点,一起来看看吧。

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https://www.youtube.com/watch?v=UXq44eXWEf8

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